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Schreidah CM, Fahmy LM, Lapolla BA, Kwinta BD, Magro CM, Geskin LJ. Clinical Remission of Primary Cutaneous Marginal Zone B-Cell Lymphoma in a Patient With Crohn's Disease After Helicobacter pylori Quadruple Therapy and Vedolizumab. Am J Dermatopathol 2023; Publish Ahead of Print:00000372-990000000-00206. [PMID: 37377200 DOI: 10.1097/dad.0000000000002470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Affiliation(s)
- Celine M Schreidah
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Lauren M Fahmy
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Brigit A Lapolla
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY; and
| | - Bradley D Kwinta
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Cynthia M Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY; and
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Magro CM, Kalomeris T, Roberts A. Primary cutaneous blastic marginal zone lymphoma: A comprehensive clinical, light microscopic, phenotypic and cytogenetic appraisal. Ann Diagn Pathol 2023; 63:152101. [PMID: 36634549 DOI: 10.1016/j.anndiagpath.2022.152101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Primary cutaneous marginal zone lymphoma (PCMZL) is a form of indolent lymphoproliferative disease where the disease is largely a cutaneous confined process. It is typically a neoplasm composed of post germinal small B-cells and light chain restricted plasma cells in a background of reactive T-cell hyperplasia and benign germinal centers. Rarely a significant degree of large cell infiltration occurs warranting the categorization as blastic marginal zone lymphoma. MATERIALS AND METHODS We reviewed our data base over a time period of 2016 to 2022 for cases diagnosed as blastic MZL. Twelve cases were identified. The clinical records and pathological data were reviewed. RESULTS Nine of the cases represented de novo forms of blastic MZL while in three cases there was a prior history of MZL. Multifocal cutaneous disease was not uncommon and one quarter of the cases had evidence of extracutaneous dissemination. All patients except three achieved remission with varied therapeutic interventions depending on the extent of the disease ranging from conservative re-excision to chemotherapy. No patient died from lymphoma. Light microscopically, there was evidence of a background of conventional MZL in the majority of cases. The large cell component was typically characterized by multiple micronodular aggregates throughout the dermis although in three cases there was a striking diffuse large cell component as the dominant infiltrate. Phenotypically, a third of the cases showed either CD5 or CD23 positivity amidst neoplastic B cells. Significant staining for BCL-2 was noted in the majority of cases tested while extensive MUM-1 positivity was observed in half of the cases tested. Kappa or lambda light chain restriction was seen in most. The Ki67 proliferation index exceeded 30 % in all cases. There was C-MYC positivity in two cases. While most cases did not detect cytogenetic abnormalities, one case had multiple cytogenetic hits that are associated with diffuse large B cell lymphoma. Next generation sequencing showed a Ten-eleven translocation 2 mutation in the earlier biopsy prior to transformation and in the later biopsy after transformation along with an additional B2M mutation in the transformed biopsy. Both types of mutations are very uncommon but held to contribute to tumor progression in the setting of diffuse large B cell lymphoma. CONCLUSION Blastic MZL is associated with a more aggressive clinical course. Even when there is disseminated disease patients while not always cured did not have a fatal course in this series. The light microscopic findings are reproducible. The background of MZL, identification of larger cells in significant numbers without a follicle center phenotype, at times expressing CD5 or CD23 with variable positivity for MUM1, BCL-2 and C-MYC and a high proliferation index define the pathology in most. Certain cytogenetic abnormalities and genetic mutations implicated in large cell transformation into a diffuse large B cell lymphoma are seen in blastic MZL with earlier biopsies prior to transformation potentially harboring at risk genetic mutations.
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Affiliation(s)
- Cynthia M Magro
- Department of Pathology and Laboratory Medicine, New York-Presbyterian/Weill Cornell Medicine, NY, New York, United States of America.
| | - Taylor Kalomeris
- Dermatopathology, East Virginia Medical School, Norfolk, VA, United States of America
| | - Alice Roberts
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, NY, New York, United States of America
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Anendaga CDM, Raghu M, Szarmach JL, Bakhru S, Flaherty FT, Boroumand G. A rare case of synchronous mucosa-associated lymphoid tissue (MALT) lymphoma involving bilateral breasts and subcutaneous tissues. Radiol Case Rep 2022; 17:4049-4052. [PMID: 36046719 PMCID: PMC9421087 DOI: 10.1016/j.radcr.2022.07.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 12/04/2022] Open
Abstract
Marginal zone lymphoma of mucosa-associated lymphoid tissue is a B-cell lymphoma which arises in extranodal sites, most commonly the stomach. Involvement of the breast is very rare. We present a case of an asymptomatic 63-year-old woman with synchronous mucosa-associated lymphoid tissue lymphoma involving both breasts and subcutaneous tissues. This represents a form of secondary breast lymphoma (given the concurrent involvement of the breast and non-mammary organ systems) and is an exceedingly rare diagnosis which, to our knowledge, has only been discussed in a few case series.
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Krenitsky A, Klager S, Hatch L, Sarriera-Lazaro C, Chen PL, Seminario-Vidal L. Update in Diagnosis and Management of Primary Cutaneous B-Cell Lymphomas. Am J Clin Dermatol 2022; 23:689-706. [PMID: 35854102 DOI: 10.1007/s40257-022-00704-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 02/05/2023]
Abstract
Primary cutaneous lymphomas are a rare group of diseases, with an estimated incidence of 0.5-1 case per 100,000 people per year. Primary cutaneous B-cell lymphomas (pCBCLs) represent 25-30% of all primary cutaneous lymphomas. There are three main subtypes of pCBCL: primary cutaneous marginal zone lymphoma, primary cutaneous follicle center lymphoma, and primary cutaneous diffuse large B-cell lymphoma, leg type. Cutaneous B-cell lymphomas have a broad spectrum of clinical presentations, which makes diagnostic and therapeutic strategies challenging. To date, treatment recommendations for cutaneous B-cell lymphomas have been largely based on small retrospective studies and institutional experience. Recently, the pharmacotherapeutic landscape has expanded to include drugs that may modify the underlying disease pathology of pCBCLs, representing new therapeutic modalities for this rare group of diseases. Novel therapies used for other systemic B-cell lymphomas show promise for the treatment of pCBCLs and are being increasingly considered. These new therapies are divided into five main groups: monoclonal antibodies, immune checkpoint inhibitors, small-molecule inhibitors, bispecific T-cell engaging, and chimeric antigen receptor T cell. In this review, we discuss the clinical, histopathological, molecular, and cytogenetic features of the most common pCBCL subtypes with a focus on current and innovative therapeutic developments in their management. These emerging treatment strategies for B-cell lymphomas and cutaneous B-cell lymphomas may represent novel first-line options for the management of these rare diseases.
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Affiliation(s)
- Amanda Krenitsky
- Department of Dermatology and Cutaneous Surgery, University of South Florida, 13320 USF Laurel Drive, Tampa, FL, 33612, USA.
| | - Skylar Klager
- Department of Dermatology and Cutaneous Surgery, University of South Florida, 13320 USF Laurel Drive, Tampa, FL, 33612, USA
| | - Leigh Hatch
- Department of Dermatology and Cutaneous Surgery, University of South Florida, 13320 USF Laurel Drive, Tampa, FL, 33612, USA
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | | | - Pei Ling Chen
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
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5
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Hristov AC, Comfere NI, Vidal CI, Sundram U. Kappa and lambda immunohistochemistry and in situ hybridization in the evaluation of atypical cutaneous lymphoid infiltrates. J Cutan Pathol 2020; 47:1103-1110. [PMID: 32870521 DOI: 10.1111/cup.13858] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/04/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Atypical cutaneous lymphoid infiltrates are challenging lesions in dermatopathology. We present a summary of the literature regarding kappa and lambda immunohistochemistry (IHC) and in situ hybridization (ISH) in the evaluation of atypical cutaneous or mucosal lymphoid infiltrates. METHODS Relevant articles from 1967 to 2018 in the English language were identified and summarized. In the absence of larger studies, case series of n ≥ 3 were included. RESULTS Sixty-three articles assessing kappa and lambda IHC and/or ISH were identified. Most focused on marginal zone lymphomas. Other lymphomas included follicle center lymphoma, diffuse large B-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, mantle cell lymphoma, lymphoplasmacytic lymphoma, plasmablastic lymphoma, multiple myeloma, monoclonal gammopathy of undetermined significance, and polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes (POEMS). Non-neoplastic lesions included reactive lymphoid hyperplasia, cutaneous plasmacytosis, connective tissue disease, IgG4-related disease, acrodermatitis chronic atrophicans, Zoon balanitis, dermatitides, and infiltrates around epithelial dysplasias/neoplasias. CONCLUSION Kappa and lambda IHC and ISH are useful tools in the evaluation of cutaneous B-cell lymphomas and plasma cell neoplasms. The literature supports that the detection of light-chain restriction by IHC and ISH is one of the most useful findings in the differential diagnosis of reactive lymphoid hyperplasia vs B-cell lymphoma with plasmacytic differentiation.
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Affiliation(s)
- Alexandra C Hristov
- Departments of Pathology and Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nneka I Comfere
- Department of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudia I Vidal
- Dermatology Center of Southern Indiana, Bloomington, Indiana, USA
| | - Uma Sundram
- Department of Pathology, Oakland University William Beaumont School of Medicine and Beaumont Health Systems, Royal Oak, Michigan, USA
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Malachowski SJ, Sun J, Chen PL, Seminario-Vidal L. Diagnosis and Management of Cutaneous B-Cell Lymphomas. Dermatol Clin 2019; 37:443-454. [PMID: 31466585 DOI: 10.1016/j.det.2019.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Primary cutaneous B-cell lymphomas are a group of diseases with indolent and aggressive behavior. The goal of the initial workup is to evaluate for systemic involvement, provide adequate staging, and guide therapy. Histopathological studies are a critical part of the workup for classification of these lymphomas because they are similar to their nodal counterparts. There are limited data for treatment guidelines, and thus, therapy differs among institutions. Overall, localized therapies are preferred for indolent types and chemotherapy or immunotherapy for the aggressive forms.
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Affiliation(s)
- Stephen J Malachowski
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Boulevard, Tampa, FL 33612, USA
| | - James Sun
- Department of Cutaneous Oncology, Moffitt Cancer Center, 10920 McKinley Drive, Tampa, FL 33612, USA
| | - Pei-Ling Chen
- Department of Cutaneous Oncology, Moffitt Cancer Center, 10920 McKinley Drive, Tampa, FL 33612, USA
| | - Lucia Seminario-Vidal
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Boulevard, Tampa, FL 33612, USA; Department of Cutaneous Oncology, Moffitt Cancer Center, 10920 McKinley Drive, Tampa, FL 33612, USA.
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Abstract
Orbital lymphomas constitute 50-60% of ocular adnexal lymphomas. A total of 2211 cases of orbital lymphoma with a known subtype have been reported in the last 24 years (1994-2017). The vast majority of orbital lymphomas are of B-cell origin (97%), of which extranodal marginal zone B-cell lymphoma (EMZL) (59%) is the most common subtype, followed by diffuse large B-cell lymphoma (23%), follicular lymphoma (9%), and mantle cell lymphoma (5%). Orbital lymphoma is primarily a disease of the elderly. Gender distribution varies according to lymphoma subtype. However, extranodal marginal zone B-cell lymphoma (53%) and follicular lymphoma (75%) show a female predominance, whereas diffuse large B-cell lymphoma shows an even gender distribution. Mantle cell lymphoma has a striking male predominance of 80%. The histopathological subtype and the clinical stage of the disease are the best indicators of prognosis and patient outcome. Low-grade lymphomas such as extranodal marginal zone B-cell lymphoma and FL have a good prognosis, whereas high-grade lymphomas (diffuse large B-cell lymphoma and mantle cell lymphoma) are associated with a poor prognosis. When managing solitary low-grade lymphomas, radiotherapy is the treatment of choice. Chemotherapy, with or without radiotherapy, should be chosen for disseminated and high-grade lymphomas.
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Affiliation(s)
- Tine Gadegaard Olsen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark.
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Abstract
Primary cutaneous lymphomas are a heterogeneous group that includes 2 main groups of primary T- and B-cell lymphomas, which can involve the skin with distinct variability in clinical presentation, histopathology, immunophenotypes, molecular signature, and prognosis. The authors describe the most frequent clinical forms of cutaneous lymphomas and their dermoscopic features. Even if the diagnosis of these entities is still based on a cellular level and the literature on dermoscopy in cutaneous lymphomas is limited and, for several entities it is based only on single case reports/case series, we think that know how they appear also in dermoscopy can be useful for helping in the clinical diagnosis.
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Chatterjee D, Bhattacharjee R. Immunohistochemistry in Dermatopathology and its Relevance in Clinical Practice. Indian Dermatol Online J 2018; 9:234-244. [PMID: 30050812 PMCID: PMC6042184 DOI: 10.4103/idoj.idoj_8_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Immunohistochemistry (IHC) is an important diagnostic tool in histopathology. Dermatopathology is a rapidly developing subspecialty of histopathology. Although IHC is not widely used in routine dermatopathology practice, its application is gradually increasing. IHC is used to differentiate two conditions with similar morphology, to confirm a diagnosis as well as to assess prognosis. It is more commonly used for neoplastic conditions like melanocytic, hematolymphoid, and spindle cell tumors, although uses can be very wide. Although IHC can aid in diagnosis, sometimes interpretation can be difficult as there may be overlapping findings. Thus, IHC should not be interpreted in isolation and should be done in the context of clinical and histological findings. In this review, we have discussed the uses of various immunohistochemical markers in dermatopathology in the light of current literature and their clinical relevance.
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Affiliation(s)
- Debajyoti Chatterjee
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Rajsmita Bhattacharjee
- Department of Dermatology, Leprology and Venereology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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11
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Magro CM, Olson LC. Small cell lymphocytic variant of marginal zone lymphoma: A distinct form of marginal zone lymphoma derived from naïve B cells as a cutaneous counterpart to the naïve marginal zone lymphoma of splenic origin. Ann Diagn Pathol 2018; 34:116-121. [PMID: 29661716 DOI: 10.1016/j.anndiagpath.2018.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 02/09/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Cynthia M Magro
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA.
| | - Luke C Olson
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
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12
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Abstract
B-cell lymphomas represent approximately 20% to 25% of primary cutaneous lymphomas. Within this group, most cases (>99%) are encompassed by 3 diagnostic entities: primary cutaneous marginal zone lymphoma, primary cutaneous follicle center lymphoma, and primary cutaneous diffuse large B-cell lymphoma, leg type. In this article, the authors present clinical, histopathologic, immunophenotypic, and molecular features of each of these entities and briefly discuss the rarer intravascular large B-cell lymphoma.
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Affiliation(s)
- Charity B Hope
- Department of Pathology, UCSF Dermatopathology Section, University of California, San Francisco, 1701 Divisidero Street, Room 280, San Francisco, CA 94115, USA
| | - Laura B Pincus
- Department of Pathology, UCSF Dermatopathology Section, University of California, San Francisco, 1701 Divisidero Street, Room 280, San Francisco, CA 94115, USA; Department of Dermatology, UCSF Dermatopathology Section, University of California, San Francisco, 1701 Divisidero Street, Room 280, San Francisco, CA 94115, USA.
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Kim DH, Nam ES, Yi JG, Shin HS, Kim IS. Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma of the Thymus. Int J Surg Pathol 2016. [DOI: 10.1177/106689699800600407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We present a rare case of primary low-grade B-cell lymphoma of the thymus. The tumor showed the typical features of a MALT (mucosa-associated lymphoid tissue) lymphoma with epithelium-lined thymic cyst. Histologically, there were sheets of centrocyte-like (CCL) cells intermingled with small lymphocytes and plasma cells. CCL cells invaded the epithelium of the cyst and residual Hassall's corpuscles, forming characteristic lymphoepithelial lesions. Immunohistochemically, the tumor cells revealed positive immunoreaction for CD20 and monotypic cytoplasmic restriction of kappa light chain.
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Affiliation(s)
| | - Eun Sook Nam
- Department of Pathology, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Jeong Geun Yi
- Department of Radiology, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Hyung Sik Shin
- Department of Pathology, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - In-Sun Kim
- Department of Pathology, College of Medicine, Korea University, Seoul, Korea
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Primary MALT Lymphoma of the Breast Treated with Definitive Radiation. Case Rep Hematol 2016; 2016:1831792. [PMID: 27247809 PMCID: PMC4877461 DOI: 10.1155/2016/1831792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/14/2016] [Accepted: 04/17/2016] [Indexed: 01/22/2023] Open
Abstract
We are reporting a case of a 59-year-old woman, with a family history of breast cancer, who presented with extranodal marginal zone lymphoma (MALT) of the left breast. She received definitive radiation therapy and remains without evidence of disease. Here, we present a case and review the current literature to determine the optimal treatment of this rare presentation of MALT.
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Lima M. Cutaneous primary B-cell lymphomas: from diagnosis to treatment. An Bras Dermatol 2016; 90:687-706. [PMID: 26560215 PMCID: PMC4631235 DOI: 10.1590/abd1806-4841.20153638] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 06/05/2014] [Indexed: 12/19/2022] Open
Abstract
Primary cutaneous B-cell lymphomas are a heterogeneous group of mature B-cells neoplasms with tropism for the skin, whose biology and clinical course differ significantly from the equivalent nodal lymphomas. The most indolent forms comprise the primary cutaneous marginal zone and follicle center B-cell lymphomas that despite the excellent prognosis have cutaneous recurrences very commonly. The most aggressive forms include the primary cutaneous large B-cell lymphomas, consisting in two major groups: the leg type, with poor prognosis, and others, the latter representing a heterogeneous group of lymphomas from which specific entities are supposed to be individualized over time, such as intravascular large B-cell lymphomas. Treatment may include surgical excision, radiotherapy, antibiotics, corticosteroids, interferon, monoclonal antibodies and chemotherapy, depending on the type of lymphoma and on the type and location of the skin lesions. In subtypes with good prognosis is contraindicated overtreatment and in those associated with a worse prognosis the recommended therapy relies on CHOP-like regimens associated with rituximab, assisted or not with local radiotherapy. We review the primary cutaneous B-cell lymphomas, remembering the diagnostic criteria, differential diagnosis, classification, and prognostic factors and presenting the available therapies.
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Affiliation(s)
- Margarida Lima
- Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
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Raderer M, Kiesewetter B, Ferreri AJM. Clinicopathologic characteristics and treatment of marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). CA Cancer J Clin 2016; 66:153-71. [PMID: 26773441 DOI: 10.3322/caac.21330] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Extranodal marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma) accounts for 7% to 8% of newly diagnosed lymphomas. Because of its association with infectious causes, such as Helicobacter pylori (HP) or Chlamydophila psittaci (CP), and autoimmune diseases, it has become the paradigm of an antigen-driven malignancy. MALT lymphoma usually displays an indolent course, and watch-and-wait strategies are justified initially in a certain percentage of patients. In patients with gastric MALT lymphoma or ocular adnexal MALT lymphoma, antibiotic therapy against HP or CP, respectively, is the first-line management of choice, resulting in lymphoma response rates from 75% to 80% after HP eradication and from 33% to 65% after antibiotic therapy for CP. In patients who have localized disease that is refractory to antibiotics, radiation is widely applied in various centers with excellent local control, whereas systemic therapies are increasingly being applied, at least in Europe, because of the potentially systemic nature of the disease. Therefore, the objective of this review is to briefly summarize the clinicopathologic characteristics of this distinct type of lymphoma along with current data on management strategies.
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Affiliation(s)
- Markus Raderer
- Programme Director for Extranodal Lymphomas, Department of Internal Medicine I, Division of Oncology, Medical University Vienna, Vienna, Austria
| | - Barbara Kiesewetter
- Resident-in-Training, Department of Internal Medicine I, Division of Oncology, Medical University Vienna, Vienna, Austria
| | - Andrés J M Ferreri
- Director, Unit of Lymphoid Malignancies, Division of Onco-Hematological Medicine, Department of Onco-Hematology, National Institute for Research and Treatment, San Raffaele Scientific Institute, Milano, Italy
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Goyal A, Moore JB, Gimbel D, Carter JB, Kroshinsky D, Ferry JA, Harris NL, Duncan LM. PD-1, S-100 and CD1a expression in pseudolymphomatous folliculitis, primary cutaneous marginal zone B-cell lymphoma (MALT lymphoma) and cutaneous lymphoid hyperplasia. J Cutan Pathol 2014; 42:6-15. [PMID: 25384543 DOI: 10.1111/cup.12440] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 09/11/2014] [Accepted: 10/12/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pseudolymphomatous folliculitis is a lymphoid proliferation that clinically and histopathologically mimics primary cutaneous extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). In this study, we assessed the diagnostic value of three immunohistochemical markers, programmed death-1 (PD-1), CD1a and S100. METHODS We evaluated 25 cases of cutaneous lymphoid proliferations with established diagnoses, including 9 patients with pseudolymphomatous folliculitis, 11 with MALT lymphoma, and 5 with cutaneous lymphoid hyperplasia (CLH). The clinical, histopathologic and immunohistochemical characteristics were reviewed and three major characteristics assessed: (a) proportion of T cells expressing PD-1, (b) pattern of expression of CD1a by dendritic cells and (c) pattern of expression of S100 by dendritic cells. RESULTS We found pseudolymphomatous folliculitis to have a significant increase in PD-1+ T cells compared with MALT lymphoma (p < 0.0001). The pattern of CD1a staining is also informative: MALT lymphoma is significantly more likely to demonstrate a peripheral concentration of CD1a+ dendritic cells around lymphoid nodules than pseudolymphomatous folliculitis (p < 0.0003) or CLH (p < 0.05). Pseudolymphomatous folliculitis demonstrates an interstitial distribution of CD1a+ cells more often than MALT lymphoma (p < 0.04). S100 staining was not a helpful discriminator. CONCLUSIONS Histopathologic factors including PD-1 and CD1a staining patterns may allow for more certainty in distinguishing lymphoid hyperplasia, including pseudolymphomatous folliculitis, from MALT lymphoma.
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Affiliation(s)
- Amrita Goyal
- Dermatopathology Unit, Massachusetts General Hospital, Boston, MA, USA
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Taghavi M, Zhang Y, Lindfors K, Aminololama-Shakeri S. Breast cancer mimic: cutaneous B-cell lymphoma presenting as an isolated breast mass. Case Rep Oncol 2014; 7:685-91. [PMID: 25473394 PMCID: PMC4241639 DOI: 10.1159/000368043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primary cutaneous B-cell lymphoma typically localizes to the skin, and dissemination to internal organs is rare. Lymphomatous involvement of the breasts is also rare. We describe the clinical and radiological findings of an unusual case of primary cutaneous B-cell lymphoma presenting as an isolated breast mass without associated skin changes. CASE PRESENTATION The patient was a 55-year-old Caucasian female who initially presented with cutaneous B-cell lymphoma around her eyes and forehead with recurrence involving the skin between her breasts. Three years after terminating treatment due to a lack of symptoms, she presented for an annual screening mammogram that found a new mass in her upper inner right breast without imaging signs of cutaneous extension. On physical examination, there were no corresponding skin findings. Due to the suspicious imaging features of the mass that caused concern for primary breast malignancy, she underwent a core biopsy which revealed cutaneous B-cell lymphoma. CONCLUSION When evaluating patients with a systemic disease who present with findings atypical for that process, it is important to still consider the systemic disease as a potential etiology, particularly with lymphoma given its reputation as a great mimicker.
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Affiliation(s)
- Margaret Taghavi
- Department of Radiology, UC San Francisco Medical Center, San Francisco, Calif., USA
| | - Yanhong Zhang
- Department of Pathology, UC Davis Medical Center, Sacramento, Calif., USA
| | - Karen Lindfors
- Department of Radiology, UC Davis Medical Center, Sacramento, Calif., USA
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Cutaneous marginal zone B-cell lymphoma with high IgA expression and IgA+ dutcher bodies: a case report. Pathology 2014. [DOI: 10.1097/01.pat.0000454442.32296.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nezhat CH, Dun EC, Wieser F, Zapata M. A rare case of primary extranodal marginal zone B-cell lymphoma of the ovary, fallopian tube, and appendix in the setting of endometriosis. Am J Obstet Gynecol 2013; 208:e12-4. [PMID: 23108066 DOI: 10.1016/j.ajog.2012.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 09/16/2012] [Accepted: 10/02/2012] [Indexed: 11/30/2022]
Abstract
Extranodal marginal zone B-cell lymphomas are uncommon. Most occur in the gastrointestinal tract. Marginal zone B-cell lymphomas of the female genital tract are rare, and few cases exist of marginal zone B-cell lymphomas of the uterus, cervix, and fallopian tubes. We report the first marginal zone B-cell lymphoma of the ovary, fallopian tube, and appendix arising in endometriosis.
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Affiliation(s)
- Ceana H Nezhat
- Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Northside Hospital, Atlanta, GA, USA
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23
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Morris S. Skin Lymphoma. Clin Oncol (R Coll Radiol) 2012; 24:371-85. [DOI: 10.1016/j.clon.2012.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 02/22/2012] [Indexed: 11/26/2022]
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24
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Fernandez-Flores A. Comments on cutaneous lymphomas: since the WHO-2008 classification to present. Am J Dermatopathol 2011; 34:274-84. [PMID: 22126841 DOI: 10.1097/dad.0b013e31821b8bfe] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The last classification of lymphomas of the World Health Organization in 2008 made a few changes from the preceding classification. Although useful, at the same time, it has posed new questions, concerns, and dilemmas which have been raised in the literature. The current report highlights some of these controversies, of each of these primary cutaneous entities, going through cutaneous mature T-cell and NK-cell neoplasms, mature B-cell neoplasms, precursor neoplasms, and other entities, which for several reasons do not fit in the previous categories. It also reviews some advances on many of these lymphomas published in the last 2 years.
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25
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26
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KAMOSHIMA Y, SAWAMURA Y, SUGIYAMA T, YAMAGUCHI S, HOUKIN K, KUBOTA K. Primary Central Nervous System Mucosa-Associated Lymphoid Tissue Lymphoma-Case Report-. Neurol Med Chir (Tokyo) 2011; 51:527-30. [DOI: 10.2176/nmc.51.527] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yuuta KAMOSHIMA
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University
| | - Yutaka SAWAMURA
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University
- Sawamura Neurosurgical Clinic
| | - Taku SUGIYAMA
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University
| | - Shigeru YAMAGUCHI
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University
| | - Kiyohiro HOUKIN
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University
| | - Kanako KUBOTA
- Department of Pathology, Hokkaido University Hospital
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27
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Dalle S, Thomas L, Balme B, Dumontet C, Thieblemont C. Primary cutaneous marginal zone lymphoma. Crit Rev Oncol Hematol 2010; 74:156-62. [DOI: 10.1016/j.critrevonc.2009.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 09/02/2009] [Accepted: 09/16/2009] [Indexed: 12/30/2022] Open
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Geyer JT, Ferry JA, Longtine JA, Flotte TJ, Harris NL, Zukerberg LR. Characteristics of cutaneous marginal zone lymphomas with marked plasmacytic differentiation and a T cell-rich background. Am J Clin Pathol 2010; 133:59-69. [PMID: 20023259 DOI: 10.1309/ajcpw64ffbttpkfn] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Primary cutaneous marginal zone lymphoma (MZL) is a common B-cell lymphoma of skin and is characterized by an infiltrate of neoplastic marginal zone B cells typically within the marginal zones of reactive lymphoid follicles and the interfollicular region. However, in our experience, many cases have underemphasized features such as marked plasmacytic differentiation and/or a prominent T-cell component, which may obscure the neoplastic B cells and lead to misdiagnosis. We wanted to draw attention to these features and have studied 15 cases of MZL with marked plasmacytic differentiation, 10 of which had numerous T cells, some with cytologic atypia, and few B cells in the interfollicular region. Plasma cells were monotypic in all cases by in situ hybridization. By polymerase chain reaction, 6 of 8 T cell-rich cases had an IGH gene rearrangement, and none were clonal for T-cell receptor gene. We discuss the terminology, morphologic features, molecular profile, behavior, and differential diagnosis of cutaneous MZL.
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29
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Hoang MP, Mahalingam M, Selim MA. Immunohistochemistry in the diagnosis of cutaneous neoplasms. Future Oncol 2010; 6:93-109. [DOI: 10.2217/fon.09.143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In recent years, there has been a significant increase in the number of diagnostic immunohistochemical stains available to pathologists and dermatopathologists. Immunohistochemistry has become an indispensable tool in dermatopathology, not only in diagnosis but also in the treatment and prognostication of cutaneous neoplasms. In this review we attempt to outline current, as well as new, immunohistochemical stains of relevance in the diagnosis and classification of cutaneous neoplasms.
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Affiliation(s)
- Mai P Hoang
- Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Warren 820, Boston, MA 02114, USA
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30
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Paulli M, Arcaini L, Lucioni M, Boveri E, Capello D, Passamonti F, Merli M, Rattotti S, Rossi D, Riboni R, Berti E, Magrini U, Bruno R, Gaidano G, Lazzarino M. Subcutaneous 'lipoma-like' B-cell lymphoma associated with HCV infection: a new presentation of primary extranodal marginal zone B-cell lymphoma of MALT. Ann Oncol 2009; 21:1189-1195. [PMID: 19858084 DOI: 10.1093/annonc/mdp454] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection has been linked to lymphoproliferative disorders. Marginal zone B-cell lymphoma (MZL) represents one of the most frequent lymphoma subtypes associated with HCV infection. We describe an unusual subset of HCV-associated MZL characterized by subcutaneous presentation. MATERIALS AND METHODS A series of 12 HCV-positive patients presenting with subcutaneous nodules that revealed lymphoma infiltration at biopsy. Molecular analysis of immunoglobulin heavy chain (IGH) gene rearrangement and FISH investigations for t(11;18)(q21;q21) and t(14;18)(q32;q21) were carried out in nine patients. RESULTS The 12 patients (median age 69.5 years), all with positive HCV serology, presented with single or multiple subcutaneous nodules resembling lipomas. Histologically the lesions showed lymphoid infiltrates, consistent with extranodal MZL of mucosa-associated lymphoid tissue (MALT). Functional IGH gene rearrangements were identified in nine tested patients, with somatic mutations in 82%, indicating a histogenesis from germinal center-experienced B cells. The t(11;18) was found in two of nine cases. Staging did not show any other lymphoma localization. In two patients, a response was achieved with antiviral treatment. Extracutaneous spread to MALT sites occurred in a case. CONCLUSIONS Our observations expand the spectrum of HCV-associated lymphomas to include a subset of extranodal MZL characterized by a novel primary 'lipoma-like' subcutaneous presentation and indolent clinical course.
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Affiliation(s)
- M Paulli
- Pathology Section, Department of Human Pathology.
| | - L Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia
| | - M Lucioni
- Pathology Section, Department of Human Pathology
| | - E Boveri
- Pathology Section, Department of Human Pathology
| | - D Capello
- Division of Hematology, Department of Medical Sciences and IRCAD, Amedeo Avogadro University of Eastern Piedmont, Novara
| | - F Passamonti
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia
| | - M Merli
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia
| | - S Rattotti
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia
| | - D Rossi
- Division of Hematology, Department of Medical Sciences and IRCAD, Amedeo Avogadro University of Eastern Piedmont, Novara
| | - R Riboni
- Pathology Section, Department of Human Pathology
| | - E Berti
- Department of Dermatology, University of Milano-Bicocca, Milano
| | - U Magrini
- Pathology Section, Department of Human Pathology
| | - R Bruno
- Division of Tropical and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - G Gaidano
- Division of Hematology, Department of Medical Sciences and IRCAD, Amedeo Avogadro University of Eastern Piedmont, Novara
| | - M Lazzarino
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia
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31
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Golling P, Cozzio A, Dummer R, French L, Kempf W. Primary cutaneous B-cell lymphomas – Clinicopathological, prognostic and therapeutic characterisation of 54 cases according to the WHO-EORTC classification and the ISCL/EORTC TNM classification system for primary cutaneous lymphomas other than mycosis fungoides and Sézary syndrome. Leuk Lymphoma 2009; 49:1094-103. [DOI: 10.1080/10428190802064925] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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32
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Lymphome cutané de la zone marginale : étude histologique et immunophénotypique de 49 cas. Ann Dermatol Venereol 2008; 135:748-52. [DOI: 10.1016/j.annder.2008.07.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
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33
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34
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Bathelier E, Thomas L, Balme B, Coiffier B, Salles G, Berger F, Ffrench M, Sebban C, Biron P, Dalle S. Asymptomatic bone marrow involvement in patients presenting with cutaneous marginal zone B-cell lymphoma. Br J Dermatol 2008; 159:498-500. [DOI: 10.1111/j.1365-2133.2008.08659.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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European Organization for Research and Treatment of Cancer and International Society for Cutaneous Lymphoma consensus recommendations for the management of cutaneous B-cell lymphomas. Blood 2008; 112:1600-9. [PMID: 18567836 DOI: 10.1182/blood-2008-04-152850] [Citation(s) in RCA: 266] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Primary cutaneous B-cell lymphomas (CBCL) represent approximately 20% to 25% of all primary cutaneous lymphomas. With the advent of the World Health Organization-European Organization for Research and Treatment of Cancer (EORTC) Consensus Classification for Cutaneous Lymphomas in 2005, uniform terminology and classification for this rare group of neoplasms were introduced. However, staging procedures and treatment strategies still vary between different cutaneous lymphoma centers, which may be because consensus recommendations for the management of CBCL have never been published. Based on an extensive literature search and discussions within the EORTC Cutaneous Lymphoma Group and the International Society for Cutaneous Lymphomas, the present report aims to provide uniform recommendations for the management of the 3 main groups of CBCL. Because no systematic reviews or (randomized) controlled trials were available, these recommendations are mainly based on retrospective studies and small cohort studies. Despite these limitations, there was consensus among the members of the multidisciplinary expert panel that these recommendations reflect the state-of-the-art management as currently practiced in major cutaneous lymphoma centers. They may therefore contribute to uniform staging and treatment and form the basis for future clinical trials in patients with a CBCL.
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36
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Rawal A, Finn WG, Schnitzer B, Valdez R. Site-specific morphologic differences in extranodal marginal zone B-cell lymphomas. Arch Pathol Lab Med 2007; 131:1673-8. [PMID: 17979485 DOI: 10.5858/2007-131-1673-smdiem] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2007] [Indexed: 11/06/2022]
Abstract
CONTEXT Lymphoepithelial lesions (LELs) are a useful diagnostic feature of extranodal marginal zone B-cell lymphoma (EMZL); however, there is scant literature comparing their frequency and morphology at various sites. OBJECTIVE To evaluate any diagnostically useful, site-specific, morphologic patterns in EMZLs. DESIGN In this retrospective review, we evaluated 136 EMZLs from different sites for LEL pattern and other pathologic differences, including CD43 coexpression and plasma cell component features. RESULTS Prominent and destructive LELs were most common in salivary and thyroid gland cases, and LELs were rare to absent in breast, skin, and ocular adnexa cases. An LEL pattern with lymphocytes "stuffing" glandular lumina was seen in lung, thyroid, and salivary gland cases. Monoclonal plasma cells were most common in breast, upper aerodigestive tract, skin, and salivary gland cases. CD43 coexpression was seen in 36% of cases, most commonly in salivary gland, stomach, and upper aerodigestive tract. CONCLUSIONS The relative importance of LEL pattern, CD43 coexpression, and clonal plasma cell component in EMZLs is site-dependent, and the differences may aid in the diagnosis of EMZLs at different anatomic sites.
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Affiliation(s)
- Ajay Rawal
- Department of Pathology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minn, USA
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37
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Monari P, Farisoglio C, Calzavara Pinton PG. Borrelia burgdorferi-associated primary cutaneous marginal-zone B-cell lymphoma: a case report. Dermatology 2007; 215:229-32. [PMID: 17823520 DOI: 10.1159/000106580] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 02/20/2007] [Indexed: 11/19/2022] Open
Abstract
An association between Borrelia burgdorferi with primary cutaneous B-cell lymphoma (PCBCL) has long been suspected but just recently, thanks to a polymerase chain reaction technique, it had been possible to demonstrate B. burgdorferi-specific DNA in skin lesions of patients with different PCBCL subtypes. Locating cases of PCBCL that are related to B. burgdorferi infection could be really important for therapeutic implications; in fact, there are several reports of PCBCL responding to antibiotic therapy against B. burgdorferi. We report a case of B. burgdorferi-associated primary cutaneous marginal-zone B-cell lymphoma that, after specific antimicrobial therapy, did not show any clinical regression. We can conclude that additional studies are necessary in order to establish the use of antimicrobial therapy in B. burgdorferi-associated PCBCL.
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Affiliation(s)
- P Monari
- Department of Dermatology, University of Brescia, Azienda Spedali Civili, Brescia, Italy.
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38
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Ferreri AJM, Zucca E. Marginal-zone lymphoma. Crit Rev Oncol Hematol 2007; 63:245-56. [PMID: 17583528 DOI: 10.1016/j.critrevonc.2007.04.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 04/11/2007] [Indexed: 02/07/2023] Open
Abstract
The term marginal-zone lymphoma (MZL) encompasses three closely related lymphoma subtypes, namely the "low-grade B-cell lymphoma of MALT type" currently named MALT lymphoma, the "nodal marginal-zone B-cell lymphoma" and a provisional entity in the REAL classification named "primary splenic MZL with or without villous lymphocytes". These entities display different characteristics, with evident clinical and biological variations according to the organ where the lymphoma arises. Marginal-zone B-cells are functionally heterogeneous and may differ with respect to the pattern of somatic hypermutation in their Ig variable genes. Sequence and mutation analysis of the rearranged Ig heavy chain variable genes and that somatic mutations pattern indicate that MZL may arise from different subsets of marginal-zone B-cells. Pathogenesis of these groups of lymphomas is correlated to chronic infections, like Helicobacter pylori, hepatitis C virus, Campylobacter jejuni, Chlamydia psittaci and Borrelia burgdorferi. Several therapeutic strategies against these malignancies exist. Surgical resection, radiotherapy and alkylating agent-based chemotherapy constitute standard approaches, while antimicrobial therapies, anti-CD20 therapy and new forms of immunotherapy constitute interesting experimental approaches. However, prospective trials on these malignancies are rare and universally accepted therapeutic guidelines do not exist. MZLs constitute an exciting investigational setting both from molecular and clinical points of view.
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Affiliation(s)
- Andrés J M Ferreri
- Medical Oncology Unit, Department of Oncology, San Raffaele Scientific Institute, Milan, Italy.
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39
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Sroa N, Magro CM. Pediatric primary cutaneous marginal zone lymphoma: in association with chronic antihistamine use. J Cutan Pathol 2006; 33 Suppl 2:1-5. [PMID: 16972944 DOI: 10.1111/j.1600-0560.2006.00506.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Primary cutaneous marginal zone lymphoma of the mucosa-associated lymphoid tissue predominantly occurs in adults and is rare in children. There have been no prior reports of this lymphoma occurring in American children. We present a case of a 15-year-old male with a history of atopic diathesis and chronic use of antihistamine agents who presented with an asymptomatic lesion on his left forearm of 6 months duration. Because histopathological and immunohistochemical studies were compatible with marginal zone lymphoma, and the patient had no associated extracutaneous disease, the diagnosis of primary cutaneous marginal zone lymphoma was rendered. Based on the patient's past medical history prior to appearance of lesion, it was postulated that the development of lymphoma was associated with the ingestion of antihistamines and further propagated by his underlying atopic diathesis.
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Affiliation(s)
- Novie Sroa
- College of Medicine & Public Health, Ohio State University, Columbus, Ohio, USA
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40
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Breza TS, Zheng P, Porcu P, Magro CM. Cutaneous marginal zone B-cell lymphoma in the setting of fluoxetine therapy: a hypothesis regarding pathogenesis based on in vitro suppression of T-cell-proliferative response. J Cutan Pathol 2006; 33:522-8. [PMID: 16872479 DOI: 10.1111/j.1600-0560.2006.00475.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Drugs may be an important cause of atypical lymphocytic infiltration. Oftentimes, these infiltrates are in the context of pseudolymphomata. We report a patient who developed lymphocytoma cutis temporally associated with initiation of fluoxetine therapy that later went on to develop cutaneous marginal zone B-cell lymphoma. The response of peripheral blood lymphocytes to fluoxetine and other drugs was examined in an attempt to ascertain the potential role for drugs in the propagation of these infiltrates. MATERIALS AND METHODS Routine light microscopic analysis and phenotypic studies were performed on tissue obtained from a skin biopsy. Lymphocyte mitogenic studies were carried out using increasing concentrations of fluoxetine, bupropion, and two anticonvulsants. RESULTS An initial biopsy was consistent with lymphocytoma cutis. The patient stopped fluoxetine associated with lesional regression. The lesions recurred despite being off fluoxetine; a repeat biopsy was compatible with marginal zone lymphoma. Lymphocyte proliferation assays revealed a suppressive effect on T-lymphocyte proliferation at physiologic concentrations. Other tested drugs did not have a similar suppressive effect. CONCLUSIONS Fluoxetine may be associated with pseudolymphomata and marginal zone lymphoma. The inhibitory effects on T-lymphocyte function and more specifically T-suppressor function may lead to excessive antigen-driven B-cell proliferation.
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Affiliation(s)
- Thomas S Breza
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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41
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Gallardo F, Bellosillo B, Espinet B, Pujol RM, Estrach T, Servitje O, Romagosa V, Barranco C, Boluda S, García M, Solé F, Ariza A, Serrano S. Aberrant nuclear BCL10 expression and lack of t(11;18)(q21;q21) in primary cutaneous marginal zone B-cell lymphoma. Hum Pathol 2006; 37:867-73. [PMID: 16784987 DOI: 10.1016/j.humpath.2006.02.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Revised: 02/09/2006] [Accepted: 02/10/2006] [Indexed: 11/25/2022]
Abstract
Inhibition of apoptosis seems to play an important role in the pathogenesis of marginal zone lymphoma. Apoptosis regulator B-cell lymphoma 10 (BCL10) may show aberrant nuclear localization in some aggressive extracutaneous MALT lymphomas, often in association with a MALT1 gene t(11;18)(q21;q21) translocation. The possible occurrence of this association in primary cutaneous marginal zone lymphoma (PCMZL) remains insufficiently explored. The aim of this study was to evaluate BCL10 protein expression pattern and its possible relationship to the presence of t(11;18)(q21;q21) and other MALT1 gene abnormalities in PCMZL and to assess their clinical significance. The study included 42 consecutive PCMZL patients diagnosed on the basis of the World Health Organization/European Organization for the Research and Treatment of Cancer classification criteria. BCL10 expression was immunohistochemically evaluated in all cases, whereas t(11;18)(q21;q21) reverse transcriptase polymerase chain reaction amplification was performed on 21 samples. In addition, the presence of other MALT1 gene translocations was explored in 26 samples by interphase fluorescence in situ hybridization using a MALT1 locus-specific probe. We observed the presence of aberrant nuclear BCL10 expression in a significant number of PCMZL cases (36%, 15/42). This aberrant expression was significantly related to the development of extracutaneous disease. In contrast, neither the t(11;18)(q21;q21) translocation nor other MALT1 gene translocations could be demonstrated. t(11;18)(q21;q21), strongly linked to extracutaneous MALT lymphomas, does not seem to play a role in PCMZL. The participation of other MALT1 gene translocations in PCMZL pathogenesis seems also unlikely.
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MESH Headings
- Adaptor Proteins, Signal Transducing/biosynthesis
- Aged
- B-Cell CLL-Lymphoma 10 Protein
- Cell Nucleus/metabolism
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 14
- Female
- History, 16th Century
- History, 17th Century
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/metabolism
- Lymphoma, B-Cell, Marginal Zone/mortality
- Male
- Reverse Transcriptase Polymerase Chain Reaction
- Skin Neoplasms/genetics
- Skin Neoplasms/metabolism
- Skin Neoplasms/mortality
- Survival Analysis
- Translocation, Genetic
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Affiliation(s)
- Fernando Gallardo
- Department of Dermatology, Hospital del Mar, IMAS, Barcelona, Spain; Catalonian Cutaneous Lymphoma Network, Barcelona, Spain.
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42
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Massone C, Lozzi GP, Egberts F, Fink-Puches R, Cota C, Kerl H, Cerroni L. The protean spectrum of non-Hodgkin lymphomas with prominent involvement of subcutaneous fat. J Cutan Pathol 2006; 33:418-25. [PMID: 16776717 DOI: 10.1111/j.0303-6987.2006.00493.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Subcutaneous T-cell lymphoma (STCL) represents a controversial entity and a confused concept in the field of cutaneous T-cell lymphomas (CTCLs). Recently, alpha/beta+/CD8+ STCL has been recognized by the new World Health Organization (WHO)-European Organization for Research and Treatment of Cancer (EORTC) classification of primary cutaneous lymphomas as a distinct entity in the group of CTCLs. OBSERVATIONS We reviewed a series of 53 biopsies from 26 patients (F : M = 19:7; median age: 48; range 18-87) of cutaneous B- and T-cell lymphomas characterized by prominent involvement of the subcutaneous tissue. We could classify our cases according to the following seven categories--(i) STCL: n = 16; (ii) extranodal NK/T-cell lymphoma, nasal type: n = 2; (iii) cutaneous gamma/delta T-cell lymphoma: n = 2; (iv) anaplastic CD30+ large T-cell lymphoma: n = 1; (v) diffuse large B-cell lymphoma, secondary cutaneous: n = 3; (vi) lymphoplasmacytic lymphoma, secondary cutaneous: n = 1; (vii) specific cutaneous manifestations of myelogenous leukemia: n = 1. CONCLUSIONS We demonstrated the protean nature of lymphomas with prominent involvement of the subcutaneous fat tissues. The term STCL should be restricted to a homogeneous group of cases characterized morphologically by an exclusive involvement of subcutaneous tissues, immunohistochemically by a T-cytotoxic alpha/beta phenotype, and biologically by a relatively good prognosis.
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Affiliation(s)
- Cesare Massone
- Department of Dermatology, Medical University of Graz, Graz, Austria
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43
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Keehn CA, Cualing H. Marginal zone lymphoma with a dual cutaneous and leukemic presentation and an aberrant myeloid-monocytic phenotype. J Cutan Pathol 2006; 33:236-41. [PMID: 16466512 DOI: 10.1111/j.0303-6987.2006.00407.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Marginal zone lymphoma (MZL) is an indolent neoplasm of mature B cells, classified by the World Health Organization into three categories: nodal, splenic, and extranodal MZL of mucosa-associated lymphoid tissue (MALT lymphoma). We present an unusual case of MZL with cutaneous, leukemic, and bone marrow involvement at presentation and expression of an aberrant myeloid-monocytic phenotype. This case is best classified as MZL of leukemic subtype.
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Affiliation(s)
- Connie A Keehn
- Department of Pathology, University of south Florida college of Medicine, Tampa, FL, USA.
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44
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Affiliation(s)
- April Chiu
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY, USA
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45
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May SA, Netto G, Domiati-Saad R, Kasper C. Cutaneous lymphoid hyperplasia and marginal zone B-cell lymphoma following vaccination. J Am Acad Dermatol 2005; 53:512-6. [PMID: 16112365 DOI: 10.1016/j.jaad.2005.04.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2004] [Revised: 04/06/2005] [Accepted: 04/15/2005] [Indexed: 10/25/2022]
Abstract
Atypical lymphoid infiltrations arose within the influenza inoculation sites of two adult female patients. One patient developed a low-grade cutaneous marginal zone B-cell lymphoma (MZL) that was responsive to local excision and radiation therapy despite spread to a distant cutaneous site. The second patient's clinical course was characterized by a locally aggressive, histologically reactive inflammatory reaction responsive only to radiation therapy after multiple failed attempts at surgical resection.
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Affiliation(s)
- Steve A May
- Department of Pathology, Baylor University Medical Center, Dallas, Texas, USA
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46
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de la Fouchardière A, Balme B, Chouvet B, Perrot H, Thomas L, Claudy A, Felman P, Salles G, Coiffier B, Berger F. Lymphomes B cutanés primitifs : corrélations anatomo-cliniques dans une série de 44 cas. Ann Pathol 2005; 25:8-17. [PMID: 15981927 DOI: 10.1016/s0242-6498(05)80094-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS histological and clinical relationship study of 44 cases of primary cutaneous B cell lymphoma, classified according to WHO classification. MATERIALS AND METHODS histological, immunological and molecular analysis was correlated with clinical data. RESULTS 33 cases (75%) were marginal zone B-cell lymphomas (MZL), with head and trunk predominance (median age = 54 years). Relapses in other mucosa-related sites occurred in 3 patients. Histological transformation implied a more aggressive treatment in 3 cases. A favorable outcome was observed in most cases. 9 (20%) diffuse large B-cell lymphomas (DLBCL) appeared as a unique nodule, with female predominance (median age = 74 years) and 4 lymphoma-related deaths which seemed age-related (> 70 years) with only one lower limb localization. Histological aggressive features were present in 3 patients with a fatal outcome. 2 (5%) WHO grade 3 follicular lymphomas (FL) had an heterogeneous phenotype, with head localization, cutaneous relapses and good outcome. CONCLUSIONS MZL, the predominant type, has a good prognosis, although transformation can occur, needing a more aggressive treatment. DLBCL, observed in older patients, has clinical and histological prognostic factors identical to extra-cutaneous lymphomas. FL appears rare and has an heterogeneous phenotype. Relationships with its nodal counterpart remains unclear.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- DNA, Neoplasm/analysis
- Fatal Outcome
- Female
- Humans
- Immunohistochemistry
- Immunophenotyping
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local
- Polymerase Chain Reaction
- Radiotherapy
- Remission Induction
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- Skin Neoplasms/therapy
- Surgical Procedures, Operative
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47
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Affiliation(s)
- M Bendandi
- Department of Hematology and Cell Therapy Area, University Clinic, University of Navarra, Avda. Pio XII 36, 31008 Pamplona, Spain.
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48
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Demirkesen C, Tüzüner N, Su O, Eskazan AE, Esçkazan AE, Soysal T, Onsun N. Primary Cutaneous Immunocytoma/Marginal Zone B-Cell Lymphoma: A Case with Unusual Course. Am J Dermatopathol 2004; 26:119-22. [PMID: 15024193 DOI: 10.1097/00000372-200404000-00006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although primary cutaneous immunocytoma/marginal zone B-cell lymphoma (PCI/MZBL) is considered as an indolent lymphoma with excellent prognosis, extracutaneous spread and even death due to disseminated disease have been reported. This is a case report of a PCI/MZBL showing dissemination to the regional lymph node and bone marrow, 22 months after the initial diagnosis. Furthermore, in the lymph node, there were focal areas of high-grade transformation. On the other hand, the bone marrow involvement displayed low-grade morphology. We suggest that it should be kept in mind that there is still a possibility of systemic involvement in PCI/MZBL.
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Affiliation(s)
- Cuyan Demirkesen
- Department of Pathology, Cerrahpasça Medical Faculty, University of Istanbul, Istanbul, Turkey.
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49
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Gallardo F, Pujol RM. Diagnóstico y tratamiento de los linfomas cutáneos primarios de células B. ACTAS DERMO-SIFILIOGRAFICAS 2004. [DOI: 10.1016/s0001-7310(04)76880-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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50
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Magro C, Crowson AN, Porcu P, Nuovo GJ. Automated kappa and lambda light chain mRNA expression for the assessment of B-cell clonality in cutaneous B-cell infiltrates: its utility and diagnostic application. J Cutan Pathol 2003; 30:504-11. [PMID: 12950502 DOI: 10.1034/j.1600-0560.2003.00102.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Primary cutaneous B-cell lymphoma (1 degrees CBCL) accounts for 25% of all lymphomas. The difficulty in distinction of reactive from neoplastic B-cell infiltrates prompts the use of molecular diagnostic adjuncts. While T-cell clonality can be seen in various reactive states, clonal B-cell infiltrates are often neoplastic; standard assays employed include polymerase chain reaction (PCR) or Southern blot analysis to assess heavy chain rearrangement. We sought to assess the utility of kappa (kappa) and lambda (lambda) mRNA expression using the Ventana automated assay (Ventana Medical Systems, Tucson, AZ, USA) in the analysis of atypical cutaneous B-cell lymphoid infiltrates. MATERIALS AND METHODS Multiple 4 micro m sections of paraffin-embedded, formalin-fixed skin biopsies from 31 patients with CBCL were placed on silane-coated slides, deparaffinized, then digested in pepsin (5 mg/ml) for 30 min at 37 degrees C. Fluorescein-tagged oligoprobes and tissue mRNA were denatured at 80 degrees C for 5 min, hybridized for 2 h at 37 degrees C, and incubated with antifluorescein alkaline phosphatase conjugates. Detection of the probe target complex employed nitroblue tetrazolium and bromochloroindolyl phosphate conjugates with a nuclear fast red counterstain. A kappa : lambda ratio > 3 : 1 was held to represent kappa light chain restriction and a kappa : lambda ratio </= 1 : 1 to indicate lambda light chain restriction. RESULTS The diagnosis in each case was determined by careful integration of clinical, histologic, and phenotypic data. The diagnoses included: pseudolymphoma (PL), marginal zone lymphoma (MZL), 1 degrees CBCL of the trunk, scalp or leg, 2 degrees lymphoma, and plasma cell dyscrasia. All but one case of lymphoma were light chain restricted. All cases of PL were proven to be polyclonal by this methodology. In non-plasmacytic small cell lymphomas, only 5-10% of the infiltrate expressed kappa or lambda, with clonality established through the abnormal kappa : lambda ratio. Interpretations were most difficult in the 2 degrees small cell-dominant follicular center cell lymphomas and easiest in cases with significant plasmacytic differentiation (i.e. MZL, immunocytomas, or plasma cell dyscrasias). CONCLUSION The Ventana kappa/lambda assay is a reliable, quick, and inexpensive way to determine B-cell clonality in cutaneous lymphoid infiltrates in paraffin-embedded formalin-fixed tissue.
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Affiliation(s)
- Cynthia Magro
- Department of Pathology, Division of Hematology-Oncology, Ohio State University School of Medicine and Public Health, Columbus, OH, USA
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